HIPAA Notice of Privacy Practices

Globe Life Insurance Company of New York

The following Notice describes how information about you may be used and disclosed, as well as how you can obtain access to this information. Please review it carefully.

This Notice gives you information required by the privacy provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (HIPAA Privacy Rules) about the duties and privacy practices of Globe Life Insurance Company of New York to protect the privacy of your medical information that we maintain as an issuer of health insurance policies that provide medical care benefits. If you enroll in Globe Life Insurance Company of New York healthcare benefits, you will receive a copy of this Notice when our records indicate that we provide healthcare benefits to you under an individual health insurance policy.

This Notice applies to the designated healthcare components of Globe Life Insurance Company of New York that use and disclose your medical information to provide medical care benefits to you under health insurance policies. We use the terms health and healthcare in this Notice to refer to the medical care benefits we provide to you. This Notice does not apply to the information that our non-healthcare components maintain about you as an issuer of life, disability, accident, indemnity, or any other non-health insurance policy.

The effective date of this Notice is April 14, 2003 and was last revised on September 23, 2013. We are required to follow the terms of this Notice until we replace it. We reserve the right to change the terms of this Notice at any time. If we make changes to this Notice, we will revise it and send a new Notice to all persons to whom we are required to give the new Notice. We reserve the right to make the new changes apply to all your medical information maintained by us before and after the effective date of the new Notice.

Purposes for which we may use or disclose your medical information without your consent or authorization include:

Healthcare Provider's Treatment Purposes

For example, we may disclose your medical information to your doctor, at the doctor's request, or for your treatment by your doctor.

Payment

For example, we may use or disclose your medical information to collect premiums, to pay claims for covered healthcare services, or to provide eligibility information to your doctor when you receive treatment. We may also use and disclose your medical information to another covered entity or healthcare provider for the payment activities of the entity that receives your medical information.

Healthcare Operations

For example, we may use or disclose your medical information (i) to conduct quality assessment and improvement activities; (ii) or underwriting, premium writing, or other activities relating to the creation, renewal, or replacement of a contract of health insurance; (iii) to authorize business associates to perform data aggregation services; (iv) to engage in care coordination or case management; and (v) to manage, plan, or develop our business. We may also disclose your medical information to another covered entity for the limited healthcare operations and activities and healthcare fraud and abuse compliance activities of the entity that receives your medical information.

Health Services

We may use your medical information to contact you to give you information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may disclose your medical information to our business associates to assist us in these activities.

As Required by Law

For example, we must allow the U.S. Department of Health and Human Services to audit our records. We may also disclose your medical information as authorized by and to the extent necessary to comply with workers' compensation or other similar laws.

To Business Associates

We may disclose your medical information to business associates we hire to assist us. Each of our business associates must agree in writing to ensure the continuing confidentiality and security of your medical information.

To Plan Sponsor

If we provide health benefits to you under a group health plan, we may disclose to the plan sponsor of your group health plan, in summary form, claims history, and other similar information. Such summary information does not disclose your name or other distinguishing characteristics. We may also disclose to the plan sponsor the fact that you are enrolled in, or disenrolled from the group health plan. We may disclose your medical information to the plan sponsor for administrative functions that the plan sponsor provides to the group health plan if the plan sponsor agrees in writing to ensure the continuing confidentiality and security of your medical information. The plan sponsor must also agree not to use or disclose your medical information for employment-related activities or for any other benefit or benefit plans of the plan sponsor.

We may also use and disclose your medical information as follows:

To comply with legal proceedings, such as court or administrative order or subpoena.

To law enforcement officials for limited law enforcement purposes.

To a family member, friend, or other person, for the purpose of helping you with your healthcare or with payment for your healthcare, if you are in a situation such as a medical emergency and you cannot give your agreement to us to do this.

To personal representatives appointed by you or designated by applicable law.

To be used for research purposes in limited circumstances.

To a coroner, medical examiner, or funeral director about a deceased person.

To an organ procurement organization in limited circumstances.

To avert a serious threat to your health or safety or the health or safety of others.

To a governmental agency authorized to oversee the healthcare system or government purposes.

To federal officials for lawful intelligence, counterintelligence, and other national security purposes.

To appropriate military authorities, if you are a member of the armed forces.

Potential Impact of State Law

In some situations, the HIPAA Privacy Rules do not preempt (or take precedence over) state privacy laws that give you greater privacy protections. As a result, the privacy laws of a particular state might impose a privacy standard under which we will be required to operate (for example, a state privacy law relating to disclosures of medical information of minors).

Uses and Disclosures with Your Permission

We will need your written authorization for the use or disclosure of psychotherapy notes, marketing, and the sale of your protected health information. Other uses or disclosures not described in this notice require your written authorization to do so. If you give us written authorization to use or disclose your medical information for a purpose that is not described in this Notice, then, in most cases, you may revoke it in writing at any time. Your revocation will be effective for all your medical information we maintain, unless we have taken action in reliance on your authorization.

Your Rights

You may make a written request to us to do one or more of the following concerning your medical information that we maintain:

To put additional restrictions on our use and disclosure of your medical information. We do not have to agree to your request.

To communicate with you in confidence about your medical information by a different means or at a different location than we are currently doing. We do not have to agree to your request unless such confidential communications are necessary to avoid endangering you and your request continues to allow us to collect premiums and pay claims. Your request must specify the alternative means or location. Even though you requested that we communicate with you in confidence, we may give subscribers cost information.

To see and get copies of your medical information. In limited cases, we do not have to agree to your request.

To correct your medical information. In some cases, we do not have to agree to your request.

To receive a list of disclosures of your medical information that we and our business associates made for certain purposes for the last eight (8) years (but not for disclosures before April 14, 2003).

If you want to exercise any of these rights described in this Notice, please contact the Contact Office (below). We will give you the necessary information and forms for you to complete and return to the Contact Office. In some cases, we may charge you a nominal, cost-based fee to carry out your request.

Complaints

If you believe we have violated your privacy rights, you have the right to complain to us or to the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with us at our Contact Office (below). We will not retaliate against you if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Contact Office

To request additional copies of this Notice or to receive more information about our privacy practices or your rights, please contact us at the following Contact Office:

In the process of providing the products and services you requested, we will collect, use and share certain information you provided. The Privacy Policy explains what information we collect and how we use that information. The policy also explains how we protect the security and confidentiality of your information.